Role of C-Reactive Protein in Deciding Duration of Antibiotic Therapy in Neonatal Septicemia

Abstract

IntroductionNeonatal septicemia is one of the commonest causes of neonatal morbidity and mortality worldwide. C-Reactive Protein (CRP) is an acute phase reactant that can be expected to fall quickly after efficientelimination of microbial stimulus due to its short half-life. CRP levels may sufficiently reflect the balancebetween microbes and immune system of the neonate for monitoring the effect of antibiotic treatmentand for guiding the duration of antibiotic therapy.
 MethodsA prospective study conducted in ninety neonates admitted with suspected neonatal sepsis during oneyear in tertiary care hospital in the department of pediatrics, College of Medical Sciences, Bharatpur,Nepal from October 2013 to September 2014. CRP was estimated within 24–72 hours of admission.Then neonates were assigned to one of 3 groups according to CRP levels. Infection unlikely group,infection likely group with two subgroups- CRP guided therapy and 7 days antibiotic therapy.
 ResultsOut of 90 cases of suspected neonatal septicaemia antibiotics were stopped in ≤7 days in 61 cases(67.8%). In 25 out of 30 cases (27.8%) of neonatal septicaemia, antibiotics were stopped after 72 hoursof initiation. In group II, antibiotics could be stopped in five days in 4 cases and remaining 26 casesantibiotics were given for 7 days. In group III, antibiotics could be stopped in 7 days in one case andremaining 29 cases antibiotics were given more than 7 days.
 ConclusionsCRP has a high negative predictive value 96-100% and can be used as a marker of neonatal sepsis toreduce duration of antibiotics.

The Role of C-reactive Protein Estimation in Determining the Duration of Antibiotic Therapy in Neonatal Sepsis

“…In the present study, NS was higher among males (62%) than females (38%), with a ratio of 1.6:1. These results are comparable to similar earlier studies [ 18 , 29 - 31 ]. The incidence of early-onset sepsis (EOS) was 73%, and late-onset sepsis (LOS) was 27% in the present study.…”

“…This is due to its brief half-life of 19 hours [16]. This leads to CRP levels reflecting the distinctive balance between the microorganisms and the immunological status of the neonate for determining the efficacy of antibiotics and thus providing guidelines regarding the duration of antibiotic therapy [16][17][18].…”